ACTA ENDOCRINOLOGICA (BUC)

Background. Vascular calcifications (VCs) represent an important complication in dialysis patients. It is still a subject of debate whether VCs are associated with low or high intact parathormone (iPTH), or if it is not any relation.\r\nThe purpose of this study was to assess the predictive value of iPTH and other mineral markers for VCs development.\r\nMethods. The study evaluated peripheral VCs in haemodialysis (HD) and peritoneal dialysis (PD) patients using radiographies. We counted a semiquantitative score ranging from 0 to 8. Each category was divided into two groups according to VCs score. We assessed the relationship between the VCs score and mineral markers.\r\nResults. A VC score=2 was positively associated with male gender, serum Ca, P, CaxP, ALP and iPTH levels in HD patients. There was no correlation with age, HD vintage, received treatment. In PD patients, did CaxP have a higher significance with VC score>/2; were iPTH, CaxP and P of higher significance for a score=5.\r\nConclusions. Hyperparathyroidism can be considered a predictor for VCs development in dialysis patients. Other risk factors are increased serum Ca, P, CaxP and ALP levels. In PD patients, high iPTH could predict VCs only for severe calcifications, but the CaxP could even predict for less extended VCs.

Introduction. Recent studies suggest that nutritional status can modify the association\r\nbetween high iPTH and mortality, especially in diabetics and older hemodialysis patients (HDP).\r\nAim. To assess the impact of mineral metabolism parameters in the survival of HDP\r\nin our area and to evidence the factors that influence iPTH levels in our HDP, which are\r\nyounger and have less frequently diabetic nephropathy as the cause of chronic renal failure\r\nthan in most published studies.\r\nPatients and Methods. A prospective cohort study of 126 HDP was recorded for\r\ndemographic, clinical and laboratory data, and after 24 months, the general mortality. Patients\r\nwere divided in two groups, survivors and non-survivors, and each of groups classified according\r\nto the time on hemodialysis (THD). The groups of non-survivors and survivors with THD more\r\nthan 10 year-period were compared to the groups with less than 10 year vintage, regarding the\r\nalbumin levels, iPTH levels, phosphate-calcium metabolism markers, age and sex.\r\nResults. We observed the better survival only for calcium phosphate product less than 55\r\nmg?/dL? (p=0,02). The iPTH level seems to be conditioned by albumin levels. For THD<10\r\nyears, iPTH levels are greater in survivors (p=0.01); in this subgroup we observed higher levels\r\nof serum albumin (p<0.001), the patients were younger (p<0.001), and had 5-fold lower\r\nfrequency of diabetes. For THD>10 years, iPTH levels are greater in non-survivor patients\r\n(p=0.02), as well as calcium, phosphorus and calcium phosphorus product.\r\nConclusions. Calcium-Phosphorus product is a better indicator for survival in HDP in our\r\narea than immunoreactive PTH levels. Immunoreactive PTH as prognostic factor might be\r\nbetter evaluated in association with calcium phosphorus metabolism parameters and albumin\r\nlevels too, even in younger and lower percent-diabetic HDP groups.

We studied the incidence, risk factors, presentation, treatment and prognosis of calcific uremic arteriolopathy (CUA) in 140 of our hemodialysis patients. Methods. Patients with CUA in the past 3 years have been compared to controls in a cross-sectional survey of 140 hemodialysis patients. Results. Prevalence of CUA was 6/140 (4.28%); common presentation was ulcerated acral necrosis. Age, sex ratio, BMI, prevalence of diabetes were similar in case (n=6) and control (n=134) patients. CUA patients had higher serum calcium (9.58?1.25 mg/dL vs. 8.50?1.03 mg/dL, p=0.01), calcium-phosphate product (71.06?19.67 mg2/dL2 vs. 58.73?17.20 mg2/dL2, p=0.01) and parathormone levels (1854?1407 pg/mL vs. 654?776 pg/mL, p=0.0002). Differences in ingestion of calcium, active vitamin D and non-calcium containing phosphate binders in the year prior to the assessment were not significant. CUA patients had higher CRP values in the 6 preceding months than non CUA patients (6.61?9.68 mg/dL vs. 1.97?4.20 mg/dL, p=0.01); logistic regression disclosed CRP as the only predictive factor for CUA (p=0.03). 4 (66%) of the CUA patients died due to sepsis, as compared to 3(2.23%) of the control group (p=0.001). 2 of 3 parathyroidectomised patients survived. In conclusion, this is, to our knowledge, the first series of CUA reported from Eastern Europe. In our center acral, ulcerated forms of CUA in patients with severe hyperparathyroidism are predominant.